As the world observes another Organ Donation Day today, the point is to create awareness on the need for organ transplantation, magnitude of the problem and the sources of transplantation among other things. Let us take a pledge to donate our organs after our death to the suffering fellow human beings who have a miserable life because of end stage organ failure.
Need for Organ Transplantation
There are many diseases that affect various organs in human body and often these diseases lead on to permanent and near complete loss of function of the organ concerned and this stage is referred to as end stage organ failure. When this happens to a patient, he cannot survive without a treatment modality that replaces the function of that particular organ. The function of the organ can be done by an artificial organ in case of kidney failure (a procedure known as dialysis) or the patient has to undergo an organ transplantation surgery.
Magnitude of the Problem
It has been estimated that every year about 150,000 new patients are diagnosed to have end stage kidney failure in our country. The quality of life of patients after kidney transplantation is excellent, compared to patients on maintenance dialysis; the overall total cost of treatment would also be less for patients who undergo transplantation than for patients on long term dialysis.
There are several thousands of patients who develop end stage liver disease and end stage heart disease in India every year; less than 500 liver transplants and less than 50 heart transplants are done in an year.
Sources for Transplantation
Obviously, the organs for transplantation need to be obtained from human beings either during life, or after death. The original concept of death has undergone a change over the last few decades. It is well established that it is the human brain that is the organ that makes us what we are. Thus, if the brain stem is dead, the person is dead, even though the heart is continuing to beat. A person who has suffered brain stem death would never ever come back to life. In India, the Transplantation of Human Organs Act (THOA) was passed in 1994 and Government of Kerala adopted the bill in 1996. The Act defines that the organ donors can be either living donors or deceased donors. Once brain death has been declared, the next of kin of the donor has to give the consent before organs are harvested from the donor. Thus, it is legal to declare brain stem death and retrieve organs from brain dead persons in Kerala from the year 1996.
THOA defines living donors as near relatives (parents, siblings, off springs and grandparents) and altruistic donors. Buying and selling of organs are prohibited under the Act and this is punishable with imprisonment and fine.
Causes of brain death?
Majority of brain deaths occur following road traffic accidents and head injury. The person would have sustained a brain injury and developed brain death; the other organs are likely to be normal and functioning well. The other causes of brain death are cerebrovascular accidents (strokes / intracranial bleeding) and prolonged cardiac arrests. The state of Kerala has about 4000 road traffic accidents in an year. Of these, about 40 to 50% have sustained brain death. If these organs can be retrieved and used for the purpose of saving lives of patients with organ failures, several hundreds of these patients can be given a second lease of life.
Kerala Fares Bad
In 2000, a registered voluntary humanitarian organisation by name Society for Organ Retrieval and Transplantation (SORT - Cochin) was formed in the city of Kochi by a group of eminent people from different walks of life; the objective of this non governmental organisation was to create awareness in the community about organ donation and to coordinate deceased donor organ transplantation amongst the hospitals in Kochi (www.sortcochin.org <http://www.sortcochin.org/>) The efforts of this society bore fruit when the first deceased donor multi organ transplantation was done in 2004 in Kochi under the supervision of SORT. Subsequently multi organ retrieval and transplantations have been done in many hospitals in Kochi.
In 2012, the Kerala Network of Organ Sharing (KNOS) was formed under the supervision of Govt of Kerala and it was named ‘Mrithasanjeevani’. KNOS registers patients who need organ transplantation, registers hospitals which have been licensed for transplantation and allocates organs to patients in different government and private hospitals in the state. Until now, over 140 kidneys, 100 livers , 15 hearts, 1 each of pancreas and small intestine have been transplanted after KNOS came into existence three years back.
- Dr V N Unni, Senior Consultant (Nephrology) and Chief of Medical Services, Aster Medcity